Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618001120 | VA |
NPI | 1013133404 |
---|---|
Provider Name | Norlando Conanan |
First Address | Vienna, VA 22182-3990 |
Second Address | Alexandria, VA 22306-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 23/01/2018 |